Impact of nutritional index on long-term outcomes of elderly patients with coronary artery disease: sub-analysis of the SHINANO 5 year registry

Abstract

Nutritional status is a novel approach to prognostic assessment in patients with cardiovascular disease. However, assessment of nutritional status in elderly patients is challenging due to the significant differences between young patients. The TCBI (Triglycerides × Total cholesterol × Body Weight Index) is a novel and simple nutritional index for predicting long-term outcomes in patients with coronary artery disease. This retrospective study evaluated the efficacy of TCBI in 597 elderly (≥ 75 years) patients enrolled in the SHINANO 5 year registry. The SHINANO 5 year registry, a prospective observational multicenter cohort study, had enrolled 1501 consecutive patients who underwent elective/urgent percutaneous coronary intervention (PCI). In this study, patients were categorized into TCBI quartile groups. The primary endpoints were the occurrence of major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, and myocardial infarction at 5 year. The mean duration of follow up was 4.3 ± 1.7 years. The average patient age was 80.9 ± 4.3 years. MACCE was observed in 61 (40.9%) patients in the lowest TCBI quartile group. Kaplan–Meier analysis demonstrated an inverse relationship between MACCE and TCBI (log-lank P < 0.001). Multivariate analysis demonstrated that low TCBI significantly predicted the incidence of MACCE (hazard ratio: 1.44, 95% confidence interval: 1.03–2.00; P = 0.031). The TCBI is useful in predicting long-term outcomes in elderly patients undergoing PCI.

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis

“…Another recent study conducted to assess the magnitude of malnutrition in diabetic patients with CAD using the CONUT score demonstrated that 60.5% of patients with both CAD and diabetes suffered from malnutrition ( 37 ). Moreover, in concordant with our findings, malnutrition determined by the various malnutrition indices was significantly associated with adverse clinical outcomes in patients with CAD ( 11 , 38 – 40 ). Therefore, clinicians need to integrate malnutrition detection into their daily practice.…”

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…Additionally, traditional risk scoring systems in patients with CCD may need to be modified to most accurately assess an older patient’s risk. 32,33 Older patients also have an increased prevalence of frailty, 34–37 malnourishment, 38–41 and cognitive decline, all of which may be associated with poor outcomes and treatment response. Equally important, older patients are more likely to prioritize the ability to remain independent, with a focus on maintaining their mobility and functional status rather than reducing their mortality rate.…”

Predictive Value of Geriatric Nutritional Risk Index in Patients With Coronary Artery Disease: A Meta-Analysis

“…Several nutritional scoring systems, including the prognostic nutritional index (PNI), CONUT, triglycerides-total cholesterol-body weight index (TCBI), Mini Nutritional Assessment (MSA), Graz Malnutrition Screening (GMS), and GNRI have been introduced for evaluating nutritional state in clinical practice. Malnutrition determined by the PNI ( 23 ), TCBI ( 24 , 25 ), and CONUT ( 3 ) was also significantly associated with adverse outcomes in patients with CAD ( 23 ). However, there is no consensus on which tools have the best predictive role in patients with CAD.…”

“…Several nutritional scoring systems, including the prognostic nutritional index (PNI), CONUT, triglycerides-total cholesterolbody weight index (TCBI), Mini Nutritional Assessment (MSA), Graz Malnutrition Screening (GMS), and GNRI have been introduced for evaluating nutritional state in clinical practice. Malnutrition determined by the PNI (23), TCBI (24,25), FIGURE 4 | Forest plots showing the pooled RR and 95% CI of major adverse cardiovascular events for the lowest vs. the highest GNRI category. RR, risk ratio; CI, confidence interval; GNRI, Geriatric Nutritional Risk Index.…”